Bulge following TRAM flap?

Question fromMegWI:
It's been 2 months since my TRAM flap breast reconstruction and I am starting to have a bulge around my abdomen where the cut was made. Should this be taken care of or do I have to live with the bulge? It doesn't hurt but is aesthetically not pleasing to me.

Answers -Maurice Nahabedian
A bulge following TRAM flap reconstruction represents a weakness in the supportive structures of the abdominal wall. Unfortunately, this will not go away on its own. Fortunately, there is a surgical procedure that we perform that can repair this bulge. It requires that we reopen the abdominal incision, tighten the supportive layer, and reinforce this layer with a synthetic material known as Marlex mesh. This is a highly successful procedure to improve abdominal contour.

Bulge and hernia are actually different and it is important to differentiate between the two. It is much more common following the TRAM procedure to develop a bulge rather than a hernia. A hernia actually represents a defect in the supportive layers of the abdominal wall, whereas a bulge represents a laxity or weakness of the supportive layer. With the hernia, there's actually a hole in the fascia and the intestines can migrate through the hole. With the bulge, it represents a weakness and the intestines don't really go through anything; they just push out on it because it's weaker. It's an area of low resistance.

In general, if a woman comes to me and is dissatisfied with her abdominal contour, then I will recommend that a repair be performed. Most women choose to have the repair performed because the abdominal appearance is bothersome to them. If it's a true hernia, then, without question, I will recommend a repair. With a bulge, a woman has more of a choice whether or not she wants it repaired.

On Wednesday, November 19, 2003, our Ask-the-Expert Online Conference was called Breast Reconstruction. Maurice Nahabedian, M.D. and Marisa Weiss, M.D. answered your questions about different techniques in breast reconstruction, the pros and cons of implants and body tissue transfers, when you might want to reconstruct, and many more issues related to rebuilding your breast/s after breast cancer surgery.

The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.